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General NPI Number Information
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NPI Number | 1215328174
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Entity Type | Individual
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Provider Name | COLLEEN ELIZABETH TEPEN AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2015
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 2920 FEE FEE RD
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-1915
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Country | US
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Telephone | 314-291-0121
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Fax |
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Provider Business Mailing Address
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Address Line | 10900 NUCKOLS RD STE 110
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City | GLEN ALLEN
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State | VA
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Zip | 23060-9246
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Country | US
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Telephone | 314-779-1929
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Fax | 833-610-2397
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2015003907
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2003005382
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2015003907
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 2003005382
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License Number State | MO
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